How 2 common drugs became a $455 million specialty pill

[Yo_Mama_Been_Loggin]

Everything happened so fast as I walked out of the doctor’s exam room. I was tucking in my shirt and wondering if I’d asked all my questions about my injured shoulder when one of the doctor’s assistants handed me two small boxes of pills.

These will hold you over until your prescription arrives in the mail," she said, pointing to the drug samples.

Strange, I thought, the doctor didn’t mention giving me any drugs.

-snip-

"Don’t worry," she said. "It won’t cost you any more than $10."

I was glad whatever was coming wouldn’t break my budget, but I didn’t understand why I needed the drugs in the first place. And why wasn’t I picking them up at my local CVS?

-snip-

As an investigative reporter who has covered health care for more than a decade, the interaction was just the sort of thing to pique my interest. One thing I’ve learned is that almost nothing in medicine—especially brand-name drugs—is ever really a deal. When I got home, I looked up the drug: Vimovo.

The drug has been controversial, to say the least. Vimovo was created using two readily and cheaply available generic, or over-the-counter, medicines: naproxen, also known by the brand name Aleve, and esomeprazole magnesium, also known as Nexium. The Aleve handles your pain, and the Nexium helps with the upset stomach that’s sometimes caused by the pain reliever. So what’s the key selling point of this new "convenience drug"? It’s easier to take one pill than two.

But only a minority of patients get an upset stomach, and there was no indication I’d be one of them. Did I even need the Nexium component?

Of course I also did the math. You can walk into your local drugstore and buy a month’s supply of Aleve and Nexium for about $40. For Vimovo, the pharmacy billed my insurance company $3,252. This doesn’t mean the drug company ultimately gets paid that much. The pharmaceutical world is rife with rebates and side deals—all designed to elbow ahead of the competition. But apparently the price of convenience comes at a steep mark-up.

https://www.msn.com/en-us/news/us/how-2-common-drugs-became-a-dollar455-million-specialty-pill/ar-BBCWdoa?li=BBnb7Kz&ocid=edgsp

[mitch96]

1. For Vimovo, the pharmacy billed my insurance company $3,252

And what would happen if you questioned your doctors actions?? THIS is why insurance costs go up.
Once my father went to the hospital for something minor. When he got his bill he noticed that he was charged for a pregnancy test!!! He called the hospital and questioned the strange charge and was told by the clerk, what do you care, the insurance is paying for it.. Well needless to say he blew up. Stupid never sleeps. We have to question this stuff at every turn....

[TexasBushwhacker]

3. I can't help but think doctors get kick backs n/t

[Pmc1962]

5. No, no, no

Honestly, I don't know any doctor that gets any kickback from any medicine.

They may have gotten an effective song and dance from the drug rep but that's it.

Really.

[TexasBushwhacker]

8. But do they even ask what these new and improved drugs cost?

And why are the insurance companies so willing to pay the outrageous prices?

[bitterross]

9. Yes, Yes, Yes they do.

They do get kickbacks and other non-cash incentives from big pharma.

http://www.npr.org/sections/health-shots/2016/03/17/470679452/drug-company-payments-mirror-doctors-brand-name-prescribing

[Pmc1962]

14. Numbers

I am not saying no doctors ever get money but they are a tiny minority.

I have been a practicing physician for 26 years. I know of zero doctors who get any money from drug companies, let alone $5000 or more! Maybe they get food with a pitch for how the pharmaceutical product is stronger/better/faster.

That report talks about doctors who get paid but doesn't say a word about what percentage of doctors fall into that category. Hardly any.

[Blue_true]

19. Your experience mirrors mine as an engineer.

Engineers that specify parts and materials uses are targets of supplier because the engineers can influence millions of dollars of purchases per year. But I have never seen an engineer is such a situation take a bride. I even refuse dinner and lunch offers because I don't want to be trapped by people trying to get on my good side and influence my decisions. If you are running your own practice, I would assume you daily have more important things coming at you than some rep trying to grease your palms.

My view on people that take bribes is that I don't want them making ANY decisions that affect the health of a business.

[mitch96]

15. There are kickback, and there are kickbacks

I've worked in hospitals for over 45 years till I retired. As for outright money kickbacks, it would be hard to prove. As for quid pro quo kickbacks,they are more common. I've over heard conversations to the effect of medical device companies, out of the goodness of their hearts giving a chairman of a departments son's soccer team new uniforms after they purchased their device. I my self was on a whorl wind tour to determine which CT scanner we should purchase. Lots of " we could do this that and the other" promises if we purchased their machine that had nothing to do with the machine or hospital.
One American company could not understand why this hospital purchased a product that was obviously more expensive and an equal or better product. The people who made the decision just "automagicallly" happened to get brand new automobiles. I told the salesman that he just did not know how the "game" was played down here in Florida... He said he had more integrity and his company didn't "play" those games... Needless to say he did not sell many machines.
I'm not saying it's right, just that it happens all too often..
m

[TexasBushwhacker]

16. I can see how that would happen

I imagine there's a lot of "well everybody's doing it" excuses too.

[Motownman78]

17. Not do they only get kickbacks

Drug Reps tend to be young and attractive.

[woodsprite]

26. You are so right!

I dropped a doc one time because I was made to wait almost an hour for an appointment because the letch was hitting on a pretty blond pharmacy rep (making a date for dinner).

Recently took part in a health services fair. Had a table across from a major insurance company. They were fast talkers, but the table that drew the most attention was a company whose 2 reps looked more like "ladies of the evening". They had people doing a double take and wondering what kind of service they provided. They were wearing club wear at a public presentation at 10am.

[mitch96]

34. Drug Reps tend to be young and attractive.

A good friend of mine worked as a drug rep for a large pharmaceutical company. She was in her mid '50's and very knowledgeable and got maneuvered out of her position. Two things she saw coming was that the industry was changing and age discrimination. Why have a knowledgeable drug rep when you hire two young silicone barbie dolls to catch the doctors eye? If they have a question they are just a text away from the answer. Same goes for the age discrimination. One "experienced and competent" senior rep cost the same as two new hires... They were very slick in how they got rid of her and covered their ass along the way. Thankfully she got a great job with very little travel so it worked out in the long run.. Talking with her old friends at the company the "Barbies" are on a revolving door. in and out in and out.....
m

[Ilsa]

27. I have wondered if doctors have a percentage ownership

in the mail order pharmacies that fill these new drug perscriptions, but I've been told "no". Yes, this has happened to me, too, with another version of 800mg ibuprofen and famotidine (nonsteroidal anti-inflammatory pain relief and antacid).

My only complaint is that the dr office has my preferred pharmacy on file, and this mail order drug requires a higher co-pay because it is more expensive.

[mitch96]

35. I have wondered if doctors have a percentage ownership

I know in my field, Doctor owned MRI scanners were rampant. A group of doctors would buy an MRI and then self refer to that scanner. Insurance paid. I don't remember his name but a California congressman (Waxman I think) put an end to that.
The big joke down here was that there were so many magnets that the compasses on aircraft pointed to So Fla instead of true north!!
Hey, wanna buy a scanner .......cheap?
m

[MineralMan]

2. See, then, the thing to do is to buy those OTC and

forget about the prescription. It's always a good idea to check medications for ingredients. Sometimes, they're available separately for a lot less. So, you take two pills instead of one. No big deal.

You can also buy the naproxen as a discounted store brand, as you can the esomeprazole or you could substitute the even cheaper omeprazole, which does the same thing.

That would bring your monthly price down even more, and if you don't need anything but the naproxen sodium, you can skip the other.

I take a statin. I was taking generic atorvastatin, but then the generic maker jacked the price way up. I called my doctor about that and he wrote a script for generic lovastatin, which costs very little.

It's the function of the medication that is important and the class of drug it's in, most of the time. There are often alternatives, particularly to two-drug combinations, that can save tons of money.

[marylandblue]

4. Insurance companies should give patients incentives to reduce costs.

Like if the doctor precribes Vimovo, but you tell the insurance company you'll take the OTC equivalent instead, they should pay for your OTC drug. It will save you and them a lot of money.

[hunter]

6. They don't really care about saving money, no yours, not theirs.

They only care about the size of the money stream they control.

The bigger the money stream, the more the guys at top can skim off for unconscionable salaries, golden parachute retirements, corporate jets, fancy offices, limousines, etc..

[stevenleser]

20. The health insurance company folks care at every level about saving money. That's how

their employees are judged from the bottom to the top. The folks who evaluate whether to pay for a drug aren't part of the income stream and thus don't control any incoming money at all.

I and many others wish the problem with those folks is that they are all too ready to pay for too much care.

[hunter]

23. I'm currently being sued for hospital bills insurance refused to cover.

That's just game to them.

The important stuff is the $2,000+ monthly premiums. The money stream.

By no fault of our own, shit fell out of the sky, my wife and I both exist in "pre-existing conditions" hell.

My wife once rode a Cobra plan to the bitter end and was on the waiting list for our state's high risk pool and she was accepted just days before no-insurance-no-chemo might have killed her.

I won't forgive.

[Hekate]

11. It's a racket, and being a naif I can only speculate how it works. I started thinking about it...

...seriously over 10 years ago when the company that handles my CPAP supplies included a copy of the bill they sent to Blue Cross in every box. Anyone with eyes could see that the 1" foam filters cost pennies, not $10+ for a 4-pack. Likewise the flexible air hose -- how in hell did they come up with a recharge rate of $60 per?!

I knew that Blue Cross presumably negotiated -- but how much? What about the uninsured? If they were sincere about cost, they could start right there. When Blue Cross wanted to bow out of California because they weren't making enough money, I called bullshit.

The whole cost structure is a racket, and the guys at the top are raking in the dough.

[TheFrenchRazor]

12. that is exactly what it is; i think our whole governtment/corporations are 99% racket. nt

[Scarsdale]

7. Recently, I had

cataract surgery. For two tiny bottles of eyedrops I was charged $220. Originally, the price was $270, util I asked about generic. I was told that I already had the generic version of one that cost $170. I am a senior citizen and had to use a credit card to partially pay for these drops. My niece who lives in the UK tells me the operation and all related costs would be free of charge for seniors over there. Hearing aides are covered, too. When will the US catch up to the rest of the civilized world, and have universal healthcare? Is it REALLY this expensive to keep the politicians in donations o their Pacs? Look at how much pharmaceutical companies and insurance companies have donated to the gop members who crafted the latest fiasco of a "healthcare bill" Addison "Mitch" McConnell got almost half a million dollars!! No wonder they all retire as multi millionaires.

[mrmpa]

13. See my two previous posts on the drug Santyl

https://www.democraticunderground.com/10027617436 Too long of a post to copy to here



Update to my post last week: 96 hour ordeal of getting mom's prescription

This was last week's post:
http://www.democraticunderground.com/10027617436

Today I went to pick up the prescription of Santyl for mom. Last week we paid $60 after receiving a $150 discount from the drug company, and mom paying $60 ($50 + $10 over the $200 mark).

The pharmacist rings up the prescription and asks for $145. I said no, it was $60 with the discount last week (Monday the 15th). He goes to the computer checks and comes back and says the $145 is with the company paying $150. I said the drug can't go up $85-$90 in one week, he says yes it can.

I declined the medication had it transferred to Walmart, where I find the goodrx.com price to be $214.80. The coupon/discount will be $150, so mom's payment will be about $64.80.

I'm not in disbelief that a pharmaceutical company will up the price by $90 in one week, especially one that discontinued the generic/cheaper version of this salve. I've also found out that since 2013, the increase in prescriptions for Santyl is about 25%, which is a reason this company is doing this.

This is obscene.

[Coventina]

18. I take the other drug mentioned in this story: Duexis.

It is prescription strength ibuprofen and pepcid combined together.

It costs me $10 for a month's supply. I have no idea what my insurance company is paying for it.

All I know is, I tried the OTC method of just taking the two drugs separately, and for whatever reason, it just doesn't work as well.

[stevenleser]

22. I wonder if in Duexis they have done something to the ibuprofen such that it delays onset

and thus allows the pepcid to start working and calm your stomach before the ibuprofen hits.

[Coventina]

32. Interesting!

Maybe so.

All I know is, somehow it works better than the OTC versions.

And for that, I'm incredibly grateful.

For those of us with constant, chronic pain, any improvement makes a real difference in our quality of life.

[jmowreader]

24. You're going to shit, Coventina

Ninety Duexis tablets, according to goodrx.com, cost nearly $2300.

[Coventina]

31. Wow. That is just bizarre.

So here's the weird thing:

When the prescription was originally sent to my regular pharmacy (CVS in Target), my insurance first required a prior authorization from my doctor. Then, when my doctor sent that, my insurance turned it down anyway.

Hence, my experience in taking the combo OTC.

In the meantime, my doctor's office said they would try submitting it to a "specialized pharmacy" (no idea what that means). There, it was approved!!



Makes me wonder if the manufacturer of the drug has some kind of special pricing deal with certain pharmacies?

[Ilsa]

28. I'm wondering if Duexis is a new favorite of orthopedic doctors.

Do you mind me asking, is yours for an ortho issue or injury? Mine is.

[Coventina]

30. Osteoarthritis.

My back and hips are 40 years older than the rest of me.

[dalton99a]

21. Kick.

[ck4829]

25. Kick

[Vinca]

29. This is why I avoid all "new" prescription drugs and most prescription drugs in general.

I'll take Aleve for $15, Alex.

[Johnny2X2X]

33. Guillotine

In all civilizations up to the US in the last few decades Drug Execs who made $Billions off from peoples' suffering would have been executed.

There are literally drug company Execs out there choosing to kill thousands of people because they can make more money from it. And it's exactly that clear to them and their partners what they are doing.

They get a choice as simple as this:
Choice A, make this drug available at a reasonable price, make a handsome profit and get rich while helping fellow citizens stay alive.
Choice B, rape the consumer and the government by charging insane prices for this same drug, thousands or tens of thousands of people will die needlessly, make insane profits and become richer than kings.

They pick B. The only shocking thing is that after they pick B the towns people don't show up at their doors with torches. These people are every bit as evil as the Nazis were. They literally look at a dying children as necessary so they can buy a 5th home or a 4th yacht. "Hey, I know your family is devastated at the loss of your 4 year old, but I really needed a 9th Rolex watch, you can understand."